Anatomic study of septocutaneous system of the human fetuses’ lower leg: Posterior tibial artery

Background/Aim. Lower-leg septocutaneous system of perforating blood vessels represents the vascular basis of fasciocutaneous flaps. Additionally, it is of a particular importance when designing distally based fasciocutaneous flaps which represent the ?workhorse? in the reconstruction of the distal third of the lower leg and foot. The aim of this study was to analyse the vascular anatomy of posterior tibial artery and its septocutaneous (fasciocutaneous) perforating arterial vessels. Methods. The dissection was conducted on 20 fetuses of both sexes and of gestational age from 20 to 28 weeks. Cluster analysis was applied to the data on vascular anatomy of posterior tibial artery and its septocutaneous performating arterial vessels. Results. A total of 212 perforating arterial vessels was identified. The average number of perforating arterial vessels was 5.32 (ranging from 4 to 7). It was identified that septocutaneous perforating blood vessels are more likely to be found at certain levels (?safe levels of finding perforators?). These are: second, third, fifth and sixth tenth (measured as a distance from intermalleolar line to popliteal crease). Conclusion. The presence of septocutaneous system of perforating blood vessels and reliability of their localization even in the fetal period allows application of these findings in the lower leg reconstructions in children of early age. It also contributes to the greater level of understanding of anatomy of the lower-leg vascular system. Finally, it provides a basis for understanding the development of this system as it is now possible to compare results obtained on fetuses with those obtained on adults.

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COLGAJO DE HEMISÓLEO A PEDÍCULO DISTAL: CORRELACIÓN ENTRE ESTUDIOS VASCULARES CADAVÉRICOS E “IN VIVO” DISTALLY BASED HEMISOLEOUS FLAP: CORRELATION BETWEEN CADAVERIC AND “IN VIVO” VASCULAR STUDIES

Revista Argentina de Anatomía Clínica ◽

10.31051/1852.8023.v2.n1.13861 ◽

2016 ◽

Vol 2 (1) ◽

pp. 31-37

Author(s):

Daniel A. Wolff ◽

Gustavo J. Armand Ugón ◽

Jesús R. Manzani

Keyword(s):

Surgical Approach ◽

Vascular Anatomy ◽

Muscle Flap ◽

Posterior Tibial Artery ◽

Vascular Studies ◽

Posterior Tibial ◽

Tibial Artery ◽

Distally Based ◽

Distal Vessel

Introducción: El éxito de éste colgajo depende de la anatomía vascular de su pedículo y de la existencia de anastomosis con pedículos proximales. Los estudios vasculares anatómicos en cadáveres fundan las bases para la realización de colgajos musculares. El cirujano debe conocer cuales de los resultados de un estudio cadavérico son aplicables al paciente. Objetivos: Estudiar en cadáveres el número de pedículos distales, su topografía y la existencia de anastomosis con vasos proximales. Luego comparar estos datos con los hallados en pacientes. Material y Métodos: En 9 piernas cadavéricas se estudió la anatomía de los pedículos distales. En 5 pacientes se realizó colgajo de hemisóleo a pedículo distal y se verificó la correspondencia de los datos cadavéricos con los hallados en el vivo. Resultados: En el grupo cadavérico los pedículos distales para el músculo sóleo se originaron tanto de la arteria tibial posterior como de la peronea. El vaso mas distal se encontró en promedio a 6,32 cm de la línea intermaleolar y su origen mas frecuente fue la arteria tibial posterior. La presencia de anastomosis no fue demostrable en las disecciones cadavéricas pero si en el vivo. Conclusiones: Los resultados cadavéricos fueron comparables con los hallazgos del modelo vivo, salvo en la identificación de anastomosis, sólo evidenciables en éstos últimos. Esta información es útil para el abordaje y localización del pedículo distal que nutre el colgajo, pero no para definir el territorio anatómico del vaso. Por lo tanto, debe conocerse que datos originados de estudios cadavéricos pueden aplicarse al vivo. Introduction: The success of this flap depends on the vascular anatomy of its pedicle and on the existence of anastomosis with proximal pedicles. The anatomic cadaveric vascular studies set the foundation for muscle flap designs. Surgeons should know which results of cadaveric studies are applicable to the patient. Our objective was to study, in cadavers, the number and situation of distal pedicles to the soleous muscle and the existence of anastomosis between them and proximal dominant vessels for this muscle, and to compare this data with those found in patients. Material and Methods: The anatomy of distal pedicles was studied in nine cadaveric legs. Distally based hemisoleus flap was performed in five patients. The correspondence between cadaveric and patients data was verified. Results: Cadaveric group distal pedicles for soleus muscle were originated from the posterior tibial artery and also from the fibular artery. The most distal vessel was found at an average of 6.32 cm from the intermaleolar line. Its most frequent origin was the posterior tibial artery. The presence of anastomosis was demonstrated in patients but not in cadaveric dissections. Conclusions: Cadaveric results were comparable with those found in patients, except for the identification of the anastomosis. This information is useful for the localization and surgical approach of the distal pedicle that nourish the flap, but not to define the anatomical territory of the vessel. Therefore, it should be known which cadaveric data can be applied to the patients.

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